December 14, 2009: The U.S. Army leadership has turned up the heat on unit commanders, when it comes to soldiers who are having problems dealing with too much stress (usually the result of too many combat tours). The brass are concerned that more stressed out soldiers will commit suicide, or even kill others. Earlier this year, the army ordered commanders to have soldiers judged to be suicide risks, wear a special reflective vest. The uproar from commanders led to this one being quickly rescinded.

A recent study revealed that, in many cases, insufficient attention is paid to the problem by the NCOs and officers. Many unit commanders were found to be not implementing procedures for monitoring and helping soldiers known to be suicidal, or otherwise suffering from severe combat stress. The procedures were not complex. For example, a soldier noted to be having stress related problems should be assigned NCOs and fellow soldiers to keep an eye on them and report additional problems, or intervene if need be. In many cases, the officers and NCOs go through the motions of keeping an eye on suicidal soldiers, but don't follow through. This happens even when the soldier exhibits symptoms of severe distress. The stress treatment clinics sometimes fail to follow procedures as well. Even the MPs (Military Police) sometimes do not act with the speed and thoroughness the procedures require.

Part of the problem was that extreme situations are rare, and the Department of Defense covers its ass by issuing a lot of regulations to deal with a wide variety of rare events. Units cannot comply with all the rules and still do their work, so commanders have to decide which of the "special rules" are necessary, and which are not. The Department of Defense tends to ignore this, and puts all the blame on the officers and NCOs of the soldiers unit.

The army is faced with two kinds of stress injuries. Short term ones are more likely to cause suicide or violent acts. Longer term impact is better documented, because the American Veterans Administration has a vast amount of data on combat veterans dating back to World War II. Meanwhile, short term stress casualties peaked for the U.S. Army in 2007, when 10,049 soldiers were diagnosed with PTSD (post-traumatic stress disorder). This was ten times the number diagnosed in 2003 (1,020). The U.S. Marine Corps saw a similar jump, from 206 to 2,114. In the last eight years, 5,000 troops have been evacuated (as medical cases) from Iraq and Afghanistan for mental disorders. Only 16 percent of those were confirmed PTSD cases, the rest were for more familiar things like severe depression. Moreover, most of the troops in Iraq and Afghanistan are not involved in combat. Yes, they are living in a combat zone, but aside from an occasional mortar shell or rocket (which usually causes no injuries), most troops tend to have air conditioned sleeping quarters, gyms, Internet access, video games, good food and excellent medical care. It's unclear how many troops actually have PTSD, although many who are in combat, definitely are stressed out and in need of help. During World War II, 25 percent of the disabling American casualties in Europe were due to PTSD, even though only 15 percent of U.S. troops were actually in combat. Most stress related illnesses come from people having a hard time just coping with life, and the unpleasant surprises that often entails. Military is much the same way, with the addition of demands for more discipline, and training to deal with more emergencies.